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Finals > Psych conditions > Flashcards

Psych conditions Flashcards

1
Q

Causes of cognitive decline

A 
Dementia
Depression
Wilson's Disease
Hypothyroidism
Alcoholic dementia
Brain injury
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2
Q

Alzheimer’s presentation

A

Struggle to remember recent events
Gradual deterioration in global cognitive function - memory loss goes back in time
Amyloid plaques and tau protein

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3
Q

Life expectancy for Alzheimer’s

A

7 years after diagnosis

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4
Q

Treatment for Alzheimer’s

A

Donepezil (acetylcholinesterase inhibitor)

Memantine (NMDA receptor antagonist)

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5
Q

Presentation of vascular dementia

A

Stepwise progression in memory loss, previous stroke, difficulty in concentration, seizures, speech disturbance

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6
Q

Treatment for vascular dementia

A

Treat risk factors e.g. hypertension, AF. Only use AChE inhibitors if have co-existing Alzheimer’s

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7
Q

Lewy body dementia presentation

A

Progressive cognitive impairment, early attention impairment, fluctuating cognition, visual hallucinations, parkinsonism

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8
Q

Treatment of Lewy body dementia

A

Acetylcholinesterase inhibitors (donepezil, rivastigime) and memantine (NDMA inhibitor) can be used.

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9
Q

What medication should be avoided in Lewy body dementia

A

Antipsychotics can lead to irreversible parkisonism.

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10
Q

What are features of frontotemporal dementia (Pick’s disease)

A 
Onset before 65
Insidious onset
Relatively preserved memory
Personality change and social conduct problems
Disinhibition
Increased appetite
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11
Q

Management of frontotemporal dementia

A

AChE inhibitors (donepezil) or memantine

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12
Q

What are some rarer causes of dementia

A 
Huntington's
CJD
HIV
B12 deficiency
Syphilis
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13
Q

Treatment for anxiety

A

Cognitive behavioural therapy, phobias - systematic desensitisation
SSRIs (sertraline)
AVOID BENZODIAZEPINES
may use proranolol etc to treat tremor

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14
Q

Treatment for OCD

A

CBT, clomipramine (tricyclic antidepressant) or SSRIs

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15
Q

Core depression symptoms

A
  1. Persistent sadness or low mood
  2. Loss of interest/pleasure
  3. Fatigue or low energy
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16
Q

Diagnostic criteria for depression

A

At least 1 core symptom most days, most of the time for at least 2 weeks

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17
Q

Associated depression symptoms

A 
Disturbed sleeo
Poor concentrtion or indecisiveness
Low self-confidence
Poor or increased appetite
Suicidal thoughts
Agitation or slowing of movements
Guilt or self-blame
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18
Q

What would be classed as mild depression

A

Four symptoms (at least one core symptom)

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19
Q

What is moderate depression

A

Five to six symptoms

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20
Q

What is severe depression

A

Seven or more symptoms +/- psychotic symptoms

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21
Q

Two questionnaires to screen for depression

A

Hospital Anxiety and depression scale

PHQ-9

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22
Q

Depression treatment

A

CBT, sleep hygiene, SSRI, TCA

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23
Q

Examples of SSRI

A

Sertraline, citalopram, fluoxetine, paroxetine

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24
Q

General side effects of SSRIs

A

GI symptomas, agitation, hyponatraemia

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25
Q

Side effects specific to citalopram

A

Prolonged QT interval, don’t use in those with long QT syndrome

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26
Q

Which SSRI would be used post myocardial infarction

A

Sertraline

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27
Q

Which SSRI would be used in children

A

Fluoxetine

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28
Q

How should an SSRI be stopped

A

Dose gradually reduced over a 4 week period (not fluoxetine)

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29
Q

SSRI discontinuation symptoms

A 
Increased mood change
Restlessness
Difficulty sleeping
Unsteadiness
Sweating
GI symptoms
Paraesthesia
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30
Q

SSRIs and pregnancy

A

Weigh up risks and benefits. Small increased risk of congenital heart defects in first trimester.
Can cause persistent pulmonary hypertension of newborn in third trimester.

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31
Q

Examples of SNRIs

A

Venlafaxine, duloxetine, mirtazapine

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32
Q

Examples of tricyclic antidepressants

A

Amitriptyline, clomipramine, imipramine

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33
Q

Side effects of tricylclic antidepressants

A

Drowsiness
Dry mouth
Blurred vision
Constipation

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34
Q

Difference between manic episode and bipolar disorder

A

Two manic episodes = bipolar disorder

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35
Q

What is mania

A 
7 DAYS OR MORE
Elated/irritable mood
Overactive, increased energy, reduced need for sleep
Poor concentration
Pressured speech
Grandiose, overconfident
Socially/sexually dis inhibited
Psychotic symptoms (grandiose delusions, delusions of reference, auditory hallucinations)
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36
Q

What is hypomania

A 
4 DAYS OR MORE
Elated, overactive, social/sexual disinhibition, poor sleep
Continues to function
Partial insight retained
NO PSYCHOTIC SYMPTOMS
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37
Q

Management of acute mania

A

Atypical antipsychotics (quetiapine, olanzapine)
Sodium valproate
Benzodiazepines
Urgent referral to CMHT

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38
Q

Long term mood stabilisation for bipolar

A

Lithium, sodium valproate, carbamazepine
Atypical antipsychotics - quetiapine, olanzapine
For depressive episodes - fluoxetine (must stop in mania)

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39
Q

Side effects of lithium

A 
Nausea/vomiting
Fine tremor
Nephrotoxicity, polyuria
Thyroid enlargement/hypothyroidism
T wave flattening
Weight gain
Idiopathic intracranial hypertension
Leucocytosis
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40
Q

How is lithium monitored

A

12 hours post dose.
After starting chek weekly and then every three months once stabled.
Thyroid and renal functioned check 6 monthly

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41
Q

What can precipitate lithium toxicity

A

Dehydration
Renal failure
Diuretics, NSAIDs, metronidazole

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42
Q

Features of lithium toxicity

A 
Coarse tremor
Hyperreflexia
Acute confusion
Polyuria
Seizure
Coma
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43
Q

How is lithium toxicity managed

A

Fluid resuscitation, haemodialysis if severe

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44
Q

Risk factors for completed suicide

A

Male, young, divorced, mental illness, chronic illness, substance misuse, previous attempt, note, attempts to not be found, violent methods

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45
Q

What is the physiological cause of psychosis

A

Excess dopamine in the mesolimbic pathyway

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46
Q

What are the first rank symptoms in schizophrenia

A

Auditory hallucinations, somatic hallucinations, thought withdrawal, thought insertion, thought broadcasting, delusional perceptions, passivity

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47
Q

What are the positive symptoms of schizophrenia

A

Hallucinations, delusions, passivity phenomena, thought alienation, lack of insight, disturbance in mood

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48
Q

What are the negative symptoms of schizophrenia

A

Blunting of affect, amotivation, poverty of speech, poverty of thought, deterioration in functioning, lack of insight

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49
Q

Other features of schizophrenia

A

Incongruity/blunting of affect, neologisms, catatonia

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50
Q

What is catatonia

A

Adopts strange poses (rigid) and inability to speak. Waxy flexibility (maintain position after being placed in it)

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51
Q

Typical antipsychotics

A

Haloperidol, chlorpromazine

Commonly cause parkinsonian side effects

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52
Q

Atypical antipsychotics

A

Olanzepine, quetiapine, risperidone, clozapine

Less likely to cause parkinsonism but cause metabolic side effects like weight gain

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53
Q

What is clozapine

A

Atypical antipsychotic, ONLY used for treatment resistant.
Risk of fatal agranulocytosis
Reduced seizure threshold

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54
Q

What is neuroleptic malignant syndrome

A

Rare condition seen in patients taking antipsychotics. May also occur with dopaminargic drugs such as levodopa (usually when stopped or reduced in dose).
Occurs within days of staring antipsychotic

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55
Q

Features of neuroleptic malignant syndrome

A 
Pyrexia
Muscle rigidity
hypertension, tachycardia
Delirium with confusion
raised creatinine - rhabdomyolysis causing AKI
56
Q

What are some extrapyramidal side effects of antipsychotics

A

Akathisia, dyskinesia, dystonia

57
Q

What are some cautions on the use of antipsychotics in the elderly

A

Increased risk of stroke and VTE

58
Q

What is Akathisia

A

Feeling of restlessnness and the inability to sit still. Usually legs are most affected.

59
Q

Treatment of akathisia

A

Remove cause e.g. antipsychotic.
Dopamine agonists - pramipexole, ropinirole
Benzodiazepines

60
Q

What is dyskinesia

A

Involuntary muscle movements similar to tics or tremor. Includes abnormal face and lip movements e.g. lip smacking and pouting

61
Q

What is tardive dyskinesia

A

Chronic dyskinesia due to long term antipsychotic treatment e.g. haloperidol

62
Q

What is dystonia

A

Repetitive muscle contractions result in twisting of limbs or abnormal fixed postures

63
Q

What is cyclothymia

A

Rapid cycling between depressive and hypomanic states

64
Q

What is thought echo

A

A patient hears aloud their thoughts shortly after thinking them

65
Q

What is loosening of association

A

Speech that is fragmented jumping from one topic to the next unrelated idea

66
Q

What is circumstantiality

A

Patient talks a lot and goes of topic before coming to answer

67
Q

What is perseveration

A

Repetition of same response regardless of question

68
Q

What is confabulation

A

Fabricated memories

69
Q

What is psychomotor retardation

A

Slowed speech, movement and impaired cognitive functioning

70
Q

What is thought disorder

A

Disruption in the structure of thought, disordganised speech. Includes pressure of speech, poverty of speech, thought blocking

71
Q

What is flattening of affect

A

No expression or emotion

72
Q

What is blunting of affect

A

Reduced expression or emotion

73
Q

What is incongruity of affect

A

Wrong emotion for situation

74
Q

What is Belle indifference

A

Associated with conversion disorder, they are not bothered by paralysis

75
Q

What is depersonalisation

A

Feel outside their body

76
Q

What is derealisation

A

Surroundings dont feel real

77
Q

What are some classes of hypnotics

A

Benzodiazepines, Z-drugs, antihistamines, clomethiazole, melatonin, barbiturates

78
Q

Name benzos used for hypnotics

A

Nitrazepam, may have residual effects the following day, GABA agonists

79
Q

Name Z-drug hypnotics

A

Zoiclone, zolpidem tartrate, act on benzodiazepine receptor, GABA agonists

80
Q

What are barbiturates

A

Severe insomnia, avoided in elderly. Phenobarbital. GABA agonist

81
Q

What is dialectic behavioural therapy

A

Type of talking therapy for those who feel emotions very strongly (EUPD)

82
Q

What is psychoanalytic psychotherapy

A

Classic psychiatry - talks about whats on your mind and the unconscious feelings behind it

83
Q

Treatment of catatonia

A

Benzodiazepines

84
Q

What can precipitate seortonin syndrome

A

SSRIs, TCAs, SNRI, MAOI, MDMA, St. John’s wort. Change in dose

85
Q

Symptoms of serotonin syndrome

A

Three categories - neuromuscular hyperactivity (tremor, hyperreflexia, clonus) autonomic dysfunction (tachy cardia, hypertension, hyperthermia, diarrhoea) altered mental state (confusion, agitation, mania)

86
Q

Treatment of serotonin syndrome

A

Benzodiazepines, cyproheptadine (blocks serotonin production) IV fluids. Medicine withdrawal

87
Q

Treatment of neuroleptic malignant syndrome

A

Bromocriptine mesylate - a dopamine agonist

88
Q

When can you restrain a patient

A

If they are putting themselves or others at risk, if restraining them is proportionate to risk, and if you have tried the least restrictive option first

89
Q

What is the most important thing about restraint and de-escalation

A

LEAST RESTRICTIVE OPTION FIRST

90
Q

Process of rapid tranquilisation

A

IM lorazepam or haloperidol combined with IM promethazine (antihistamine)

91
Q

Stats of delirium

A 
30% of elderly patients admitted to hospital
>65
background of dementia
frailty or multimorbidity
polypharmacy
92
Q

Precipitating events for delirium

A 
Infection - UTI
Hypercalcaemia/hypoglycaemia/dehydration/other metabolic causes
Change of environment
Severe pain
Alcohol withdrawal
Constiption
93
Q

Features of delirium

A 
Memory disturbance (short term)
Agitated/withdrawn
Disorientation
Mood change
Visual hallucinations
Disturbed sleep cycle
Poor attention
94
Q

Management of delirium

A

Treat underlying cause, modify environment.

Haloperidol first line sedative

95
Q

Types of delirium

A

Hypoactive (most common)
Hyperactive (most recognised)
Mixed

96
Q

Anorexia criteria

A

BMI below 18.5 (this may now be excluded)

  1. Restriction of energy intake to lose weight
  2. Intense fear or gaining weight even though underweight
  3. Disturbance in perception of body
97
Q

Symptoms of anorexia

A

Low BMI, rapid weight loss, dieting that worries family, social withdrawal, disproportionate concern about weight, menstrual changes, dizziness, palpitations

98
Q

Treatment for anorexia

A

Family therapy <18, CBT. Fluoxetine

99
Q

Signs of anorexia

A

Bradycardia, hypoension, enlarged salivary glands, hypokalaemia, low FSH, LH, impaired glucose tolerance, low T3

100
Q

Bulimia criteria

A

Recurrent episodes of binge eating with a sense of lack of control
Compensatory purging (laxative, fasting, exercise, vomiting)
Distorted view of body image

101
Q

Treatment for bulimia

A

Family therapy <18, CBT, fluoxetine

102
Q

what is anankastic personality disorder

A

another name for OCD

103
Q

What is phenelzine

A

Monoamine oxidase inhibitor. Avoid in ECT therapy, avoid tyramine rich food (cheese, salami, marmite) as can cause life-threatening hypertensive crisis

104
Q

What would be used as a mood stabiliser second line to lithium in bipolar

A

sodium valproate

105
Q

what is the treatment for delirium tremens

A

pabrinex+high dose benzo

106
Q

which vitamin is thiamine

A

B1

107
Q

Name the 5 ICD-10 criteria for delirium

A 
impairment of consciousness
global disturbance in cognition
psychomotor disturbance
disturbance of sleep-wake cycle
emotional disturbances
108
Q

name some ICD10 criteria for agoraphobia

A 
fear of:
crowds
public spaces
travelling alone
travelling away from home
\+ 1 symptom of autonomic arousal
109
Q

What blood results would you find in neuroleptic malignant syndrome

A 
raised creatinine kinase
raised WCC
deranged LFTs
acute renal failure
metabolic acidosis
110
Q

Which drug can treat and prevent extra-pyramidal side effects of antipsychotics

A

procyclidine (anti-cholinergic)

111
Q

What can be used to reverse the sedative effects of benzos

A

flumazenil

112
Q

What is the first-line treatmet for PTSD

A

Trauma-focused CBT, EMDR is used more specifically

113
Q

What is knights move thinking

A

Anther term for loosening of association!

114
Q

How long should an SSRI be triad for in OCD

A

12 weeks

115
Q

Name some drugs that are known to induce delerium

A

Furosemide
oxybutinin
propranolol
ranitidine

116
Q

When do you do blood tests for clozapine

A

once a week for 18 weeks then fortnightly for a year, then monthly

117
Q

symptoms of GAD

A 
excessive worry
distress and functional impairment
restlessness
easily fatigued
poor concentration
irritability
muscle tension
trembling
sweating
dry mouth
palpitations
dizziness
118
Q

mnemonic for remembering delirium triggers

A 
Pain
Infection
Nutrition
Constipation
Hydration
Medications
Electrolyte disturbance
119
Q

how is acetlycysteine infusion fiven

A

within eight hours of ingestion if levels are above the treatment line.
Given in three infusions, the first over an hour

120
Q

when can activated charcoal be given for overdose

A

within one hour of ingestion

121
Q

what can be used other than chlorodiazepoxide for alcohol withdrawal

A

lorezepam - remember its just a fancy name for a benzo

122
Q

first line management for borderline personality disorder

A

dialectical behavioural therapy

123
Q

withdrawal symptoms within 24 hours of high cocaine use

A 
anxiety
increased hunger
fatigue
irritability
lack of motivation
124
Q

Which antidepressants have the strongest association with hyponatraemia

A

SSRIs,

consider hyponatraemia in those presenting with drowsiness, confusion and convulaions

125
Q

What can be used as an alcohol deterrent

A

disulfiram - causes diaphoresis, palpitation, flushing, nausea and headache if alcohol is ingested

126
Q

why would morphine, oxycodone and oxybutinin cause delirium

A

all cause constipation

127
Q

what blood tests should be monitored on lithium

A

TFT, U&Es, eGFR

128
Q

what tests should be done to exclude an organic cause for anxiety

A

24-hour urine metanephrines (phaeochromocytoma) (causes panick attacks due to high adrenaline)
ECG
FBC + iron
TFTs

129
Q

what is lillliputain

A

seeing lots of small people - typically seen in selirium tremens

130
Q

what combination of drugs is most likely to cause serotonin syndrome

A

SSRI + MAOI

131
Q

mechanism of disulfiram

A

nuild up of acetaldehyde to cause flushing and headache on consumption of alcohol

132
Q

side effects of mirtazapine

A

SNRI, drowsiness, weight gain

133
Q

absolute contraindication for ECT

A

raised ICP (only absolute)

134
Q

poor prognostic factors for schizophrenia

A

gradual onset, low IQ, family history, premorbid social withdrawal, no obvious precipitant

135
Q

examples of drugs that can induce psychosis

A 
anti malarial
bromocriptine
levodopa
steroids
alcohol
cocaine
amphetamine
MDMA
ket
136
Q

which tool is used to screen for post natal depression

A

Edinburgh scale

137
Q

methylphenidate drug reacctions

A

carbamazepine
isocarboxazid (MAOI)
linezolid (antibiotic)
risperidone (atypical antipsychotic)

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